Healthcare Provider Details

I. General information

NPI: 1316074727
Provider Name (Legal Business Name): ROBERT W MECKER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL DR
BELLEVILLE IL
62226-5360
US

IV. Provider business mailing address

5667 COUNTRY CLUB RD
WASHINGTON MO
63090-5242
US

V. Phone/Fax

Practice location:
  • Phone: 618-257-5879
  • Fax: 618-257-6740
Mailing address:
  • Phone: 636-221-1155
  • Fax: 636-583-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2012003469
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036113285
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: